This morning my google alert went crazy with multiple stories about a recent publication in the journal of physiologyof a study by Professor Peter Stone and othersOf the media who reported this study probably the least sensationalist and best summary of the research was one by Honor Whiteman writing for medical news todayIn a nutshell this study reported a controlled experiment of 29 well pregnant women who were monitored in different positions for 30 minute periods during the day. In this ground breaking study they avoided ‘high risk’ women with comorbidities and also did not monitor their participants during sleep. In doing so they had probably as clean a look as is currently possible at the human fetus’ response to the maternal supine position when compared to the same fetus spending the same time with the mother lying in other positions.It is very interesting that they found an increased likelihood of fetal quiescence in the supine position especially as this was in a group of normal healthy late third trimester pregnancies. As they say, this finding suggests that the well fetus is able to mount an adaptive response to this potential stressor by shifting to a lower oxygen consuming state. If they have found this in the well fetus, during a 30 minute period in the supine position, with the mother awake, one can only speculate as to what might occur in a vulnerable fetus, whose mother is sleeping supine for several hours during the night.Professor Stone concludes his study by saying “The supine position maybe disadvantageous for fetal wellbeing and in compromised pregnancies may be a sufficient stressor to contribute to fetal demise.” He also says that now they have found this during the day that the next logical step is to monitor women at night.This study lends weight to the four epidemiological studies published to date that have all reported significant increased risk of stillbirth associated with the supine sleep position. It is therefore disappointing that some of the other stories reporting this study have kind of missed the point.For example a live science story asks Does Lying on Your Back During Pregnancy Increase Stillbirth Risk? and suggests that some unnamed “experts” say that it's too early to make recommendations based on the findings from this study, and that pregnant women do not need to change the way they lie down as a result of the study. This misses the point because the study wasn’t actually looking at risk for stillbirth, per se but simply set out to show what happens to a well fetus when the mother lies on her back. Then the live science report goes on to say

"It is not possible to draw a firm link between maternal position and stillbirth risk from this study and further robust research is needed," Hannah Knight, a spokesperson for the Royal College of Obstetricians and Gynaecologists in the United Kingdom, said in a statement. "Women should sleep in a position that is comfortable for them," Knight said.

This makes me want to ask Hannah “how much more evidence do you need?....when is enough enough? She also is quoted as saying:

“It is important that women are not unnecessarily alarmed by the results of this small study of 29 women, none of whom had a stillbirth," Knight said. She also noted that the study measured the occurrence of a sleep-like state in the fetuses, "which has little evidence of any association with hypoxia, brain damage or stillbirth."

Here Hannah misses the point COMPLETELY, the fact that no one had a stillbirth really is beside the point. The study did not measure the occurrence of a sleep like state it measured what happened to fetal heart rate when the mother was in various positions and FOUND that a sleep like state was much more likely to occur when the mother was supine. Far from having “little evidence” in fact we have mounting evidence that points to an association between supine sleep and stillbirth.The UK Sun also reported the study with a sensational headline PREGNANCY PERIL Mums-to-be warned that sleeping on back can seriously ‘increase risk of stillbirth’ : Even reclining on the sofa for half-an-hour could be dangerous to unborn babies, researchers warnThis report kinda gets it wrong too by overstating, or wrongly stating what the study actually found eg

It follows a study that found lying back can reduce oxygen supply to babies in the womb.

The biggest danger period seems to be the last three months of pregnancy.

New Zealand scientists found babies’ heart rates and oxygen supplies dropped when expectant mums lay flat on their back just for 30 minutes.

The study actually showed that the unborn baby was more likely to enter a period of quiescence which is an oxygen saving state. It did not show a drop in heart rate associated with the supine position and while they studying women in late pregnancy this is because they have a baby big enough to compress the inferior vena cava not to say that this is definitively the “biggest danger period” for stillbirth. So again disappointingly sensational and just a little wrong.So what now? Well to be frank I’m excited. Excited that we have a well conducted study that has added an important piece of the puzzle to what we already know. That is: sleeping on your back in late pregnancy is probably not a good idea and is best avoided by asking pregnant women to settle to sleep on their side.

My daughter Cate has just had a beautiful baby…. Her first….a little girl. It is not an over exaggeration to say she is very lucky that she has me as a mother because if not for me things may well have been very different for her and her baby. Here is why……Last Sunday as we were eating family dinner she suddenly shook herself and said “gosh I’m itchy” My midwife lizard brain was immediately on high alert as this is a cardinal sign of Obstetric Cholestasis, a condition that puts the unborn baby at significant increased risk of stillbirth. It turns out that she was indeed diagnosed with a nasty case of Obstetric Cholestasis and after an anxious few days wait she was induced. Putting it frankly she was induced at 37 weeks in order to prevent stillbirth. While we will never know how close she actually came to losing her baby this has caused me to reflect on the messages we give pregnant women and those we don’t.Cate’s pregnancy has been an interesting journey for me. It has been interesting to hear when and where she has been told information and the nature of that information. She was told to avoid alcohol altogether and given the usual messages about avoiding soft cheeses. She was immunised against whooping cough and told that it would be wise to ask her family members to get a booster too. She was told to get to know her baby’s individual pattern of movements and immediately report any changes. When she presented with itchiness they followed the SA perinatal practice guidelines to the letter. All of this reflects superb care that I, for one, have been very impressed with.So what is my point? ...well it’s this. She had outstanding care and she took amazing care of herself yet she still came uncomfortably close to stillbirth. Why didn’t Cate know that itchy hands and feet during pregnancy is not normal and needs to be reported? Because no one told her. Why didn’t they tell her? Well that is an interesting question. “Obstetric Cholestasis is rare”, you might say and I would agree BUT fetal alcohol syndrome , listeriosis and whooping cough in the newborn are vanishingly rare yet she knew about and took steps to avoid each of these. So it is hard to justify why she knew about these more rare risks and took steps to avoid them, yet didn’t know about a more common condition.I think the reason why she didn’t know about Obstetric Cholestasis came down to her care providers (excellent as they were) not being prepared to have a conversation with her which was about preventing stillbirth. I have no doubt that this was motivated by a desire to avoiding “making her anxious” but if by possibly avoiding a little anxiety you end up with a stillborn baby then that’s a huge risk that should not be taken. Cate was quite happy to avoid alcohol, soft cheese and to be immunised she is a good mother who has the best interests of her baby at heart. Yet for some reason her care providers did not give her all the information that she needed to keep her baby safe. Avoiding alcohol, listeriosis and whooping cough did NOT make her anxious, it empowered her and enabled her to demonstrate she is a good mother. Therefore, withholding information which could well be the difference between life and death for fear of provoking a little anxiety is not only totally unethical but simply WRONG WRONG WRONG.Thank God, she and her baby are ok, but was lucky, lucky that she happened to mentioned it to me, lucky that I knew it wasn’t normal even if she thought it was. BUT a baby’s life should not come down to luck. Maternity care providers need to give ALL mothers ALL information to keep their baby safe. We need to stop thinking that information causes anxiety… it doesn’t it empowers women… BUT even if it did there is no way a little anxiety is worse than a lifetime of grieving a stillborn baby. Let’s trust and empower pregnant women and give them the information they need. Can we start today please?